12.3.1: Bathing, Back Rubs and Assisting with a Clean Dressing

Assisting a patient with regular bathing is important for patient health and for promoting self-esteem and healing. Patients who are recovering from an injury or illness, have a chronic condition, are permanently disabled, dying, or who are frail may require assistance with performing this essential task. This is an important part of the job of a Home Health Aide/Personal Care Aide. The Care Plan will direct the HHA/PCA as to the frequency and type of bath that should be performed. At minimum, a patient should have their face and genital areas cleansed daily in the morning. In the evening, HHAs/PCAs should offer to assist or provide the patient with evening care. This includes washing the face, brushing teeth, and any other area the patient wishes.

Providing for personal care gives Home Health Aides/Personal Care Aides an opportunity to assess a patient’s skin and to communicate with patients about their thoughts and feelings. The HHA/PCA should observe the patient’s skin for changes in color, temperature, swelling, new bruises, open areas, red areas, or sores. These should be documented and the supervisor informed.

Home Health Aides/Personal Care Aides should always encourage the patient to perform any personal hygiene task they are able and provide assistance as needed. Some patients may be able to bathe or shower independently, or with minimal assistance. Some patients will require complete (or total) care, meaning the HHA/PCA will have to provide their personal hygiene care completely. If a patient is immobile, weak, or frail, bed baths should be provided instead of risking a patient fall in a bath tub. Never allow a weak or frail patient to stand in a shower alone. In these types of situations, a tub or bed bath may be more appropriate. The HHA/PCA can also shampoo the patient’s hair in bed by using a shampoo tray.

Patients have a right to refuse any treatment, including bathing. The Home Health Aide/Personal Care Aide should provide education to the patient about the importance of bathing. Try to find out why the patient does not want a bath. Sometimes, the patient may not want a bath at that moment but would be willing to have one at a later time. Document the reason and patient refusal and inform the supervisor.

When providing or assisting with a bath, water temperature should be checked. The temperature should be no greater than 105 degrees Fahrenheit. Allow patients to test water temperature to determine if it is comfortable for them. It is very important when providing or assisting with a bath that the patient is provided with privacy. This includes closing doors, drawing curtains, and limiting access of the area to others while the patient is bathing. Towels or bath blankets can be used to cover the patient’s body, exposing only the body part being washed during bed baths.

Providing a back rub after a bath, before bed, or anytime a patient needs to relax is an important skill for the Home Health Aide/Personal Care Aide. This is an excellent way to teach a patient how to relax, assess their skin, and promote good circulation. We will discuss the proper way to give a back rub.

Instructions for providing a tub or shower bath, assisting with a transfer into and out of a tub, providing a bed bath, shampoo in bed, back rub, and how to assist with changing a clean dressing are provided in this section. Home Health Aides may never perform sterile dressing changes. They may only assist with non–sterile or clean dressing changes. Personal Care Aides may not perform any type of dressing change.